<P>Obesity Prevention and the Middle Grades
<P>Obesity prevention is a concern for schools because physical health affects academic success and is an important component of students' development in the middle grades. 
<P>By Christine Blaber and Leslie F. Hergert


<P><H1>Obesity Prevention and the Middle Grades</H1>
<P>By Christine Blaber and Leslie F. Hergert
<P>We are currently in the midst of an epidemic of obesity: there are an estimated nine million obese children over six years of age in the United States. Although the underlying causes of obesity are complex and are influenced by a number of factors, including behavior, genetics, environment, and culture, it is known that overweight and obese children are at risk for a variety of serious health consequences, including diabetes, high blood pressure, sleep apnea, orthopedic problems, and psychosocial problems. Obese children and adolescents are also often teased or bullied by their peers. Young people who are overweight and have decreased levels of self-esteem report higher rates of nervousness, sadness, and loneliness, along with greater use of cigarettes and alcohol, than their peers who are not overweight (Strauss & Pollack, 2000). 
<P>One recent study conducted at the University of South Carolina (abstract available at <a href="http://www.nature.com/oby/journal/v16/n8/abs/oby2008296a.html">www.nature.com/oby/journal/v16/n8/abs/oby2008296a.html</a>) with a nationally representative sample of more than 2,500 children ages 8 to 16 found that students' increased body weight was independently associated with decreased cognitive functioning--in this case, impaired visuospatial organization and general mental ability (Li, Qi, Jackson, & Zhang, 2008). 
<P><B>Spreading the Message</B>
<P>School leaders must promote the development of healthy minds <I>and</I> healthy bodies, but schools are often challenged to find time for everything that affects young adolescents. Nutrition and physical activity are critical issues for early adolescents, but education on these issues often gets squeezed into jam-packed health and physical education classes or family and consumer sciencescurricula, where it competes for time with other social issues, such as bullying and substance abuse prevention. 
<P>In this crucial time of life, students need to learn about healthy eating and physical activity. The following messages are important for everyone:
<UL><LI>Food and physical activity are to be enjoyed.</LI>
<LI>Being healthy doesn't mean giving up everything that is pleasurable.</LI>
<LI>Bodies need physical activity as much as they need healthy food and sleep.</LI>
<LI>You can find ways to be physically active that suit your interests and style.</LI></UL>
<P>Schools have many opportunities to provide these positive messages--in announcements and visual materials posted around the school, in the ways time is scheduled, and in the food and beverages available on school grounds, to name a few examples. Although time in academic subjects is a precious commodity, teachers can include positive messages about healthy eating and physical activity in many curricular areas. 
<P>Demands to cover subject matter and prepare for standardized tests are intense in the middle grades, but the real demand is for student mastery of knowledge and skills. Introducing the topics of nutrition and physical activity can make core subject areas come alive for students. Using engaging, real-world examples and materials can help students master the subjects they are learning and provide new ways to introduce key messages. 
<P>For example, middle grades students are expected to demonstrate literacy skills across content areas. To meet this requirement, young adolescents need to be more engaged with the content of the texts that are used throughout the curriculum. Numerous young adult novels deal with issues related to eating, body weight, and physical activity. <I>One Fat Summer, Huge,</I> and <I>Jelly Belly</I> all feature middle-grades characters struggling with weight loss. Sports fiction is popular with many students; principals can ensure that books are available that feature a wide range of traditional sports and other activities. Mike Lupica--a sports journalist--wrote novels about baseball, basketball, and football that have become <I>New York Times</I> bestsellers. Jerry Spinelli's <I>There's a Girl in My Hammerlock</I> is about a girl who tries out for a wrestling team.
<P>The nonfiction book <I>Hungry Planet: What the World Eats</I> features photographs of 30 families around the globe, each with a week's worth of food purchases. <I>Hungry Planet</I> makes world history come alive with engaging text and photographs that illustrate how diet is influenced by forces such as poverty, war, and globalization. Poetry about food and physical activity is another way to include literature on topics related to healthy living. 
<P><B>Prevention Curricula</B>
<P>The following programs offer rich opportunities for merging the topics of nutrition and physical activity into mainstream middle-grades curriculum. 
<P>Planet Health is an interdisciplinary curriculum for grades 6-8 that was developed, field tested, and evaluated by the Harvard School of Public Health. It focuses on improving health and well-being while building and reinforcing skills in language arts, math, science, social studies, and physical education. Classroom and physical education activities are designed to increase activity, improve dietary quality, and decrease inactivity.
<P>Designed for use by teachers in the core subject areas as well as health and physical education, Planet Health provides 35 lesson plans on healthy nutrition and physical activity, as well as directions for implementing a classroom or schoolwide campaign to reduce TV and other media viewing. A large-scale controlled study of the curriculum demonstrated that it reduced obesity rates in girls and reduced television viewing among boys and girls (Gortmacher et al., 1999).
<P>The Education Development Center recently produced Getting Active and Eating Well, a set of curriculum modules that incorporates information about healthy living with literacy skills and content knowledge. Divided into four units, the curriculum combines reading and health education to equip middle-grades students with the information and skills they need to make healthy food choices and initiate regular physical activity. Each curricular unit includes a key message related to nutrition or physical activity, as well as a significant reading or writing task. For example, the program's Healthy Eating Around the World unit was written for the social studies teacher and includes a research project that is suited to world history and social studies classes. Students have the opportunity to explore the diets of diverse cultures and to analyze the nutritional value of a variety of meals. 
<P>The Edible Schoolyard (<a href="http://www.edibleschoolyard.org">www.edibleschoolyard.org</a>) and KidsGardening.org (<a href="http://www.kidsgardening.org">www.kidsgardening.org</a>) provide resources on creating school gardens and linking them with classroom learning about healthy eating. More than 1,200 schools have started gardens and involved their students in growing food to eat at school or donate to local food pantries. 
<P><B>A Comprehensive, Schoolwide Approach</B> 
<P>Because the approach we recommend is comprehensive and multidisciplinary, it is ideal for principals to take on this issue and encourage teachers to incorporate messages about nutrition and physical activity in their classes. In addition, principals can champion a comprehensive approach to obesity prevention by employing the following guidelines.
<P><B>Offer healthy and appealing food and beverage choices.</B> If your school does not yet have policies that determine which foods can be sold on the school campus, this is an important step to take. In fact, the Child Nutrition and WIC Reauthorization Act of 2004 requires all school districts to establish wellness policies that provide healthful nutrition guidelines that meet or exceed U.S. Department of Agriculture regulations for schools. The guidelines apply to foods sold in school vending machines, after-school programs, fundraising campaigns, and as  la carte items in the cafeteria. Nutrition professionals in your district, such as your school nutrition director, can help develop and implement this plan.  
<P>Another important step to take is to survey students about the healthy food choices they prefer.  Survey results can help food service staff members develop menus that provide healthy options to students while retaining or even increasing cafeteria and vending machine sales. Some schools also sponsor periodic taste tests to introduce students to new foods.
<P><B>Engage parents and families in supporting students' healthy food and physical activity choices.</B> When the adults in children's lives improve their own eating and physical activity habits--by changing the foods that are prepared at mealtimes and available to snack on and increasing the kinds of physical activities that the family participates in--these changes affect the whole family. To encourage healthy habits at home, some schools include suggestions about healthy eating and physical activity in messages sent home. If the school has a monthly newsletter, include healthy recipes, tips on how to incorporate more healthful foods in families' diets, and suggestions about increasing physical activity and decreasing time in front of the TV and electronic media.  Inviting parents and caregivers to have lunch with their children in the cafeteria a few times a year is a good way to engage and inform them about school lunch activities. If your school has a gymnasium, consider making it available to families in the evening and on weekends.  
<P><B>Ensure that students engage in adequate physical activity during the school day.</B> The National Association for Sport and Physical Education recommends that middle-grades students have at least 225 minutes of physical education every week. A strong physical education program that requires student participation will help students meet this recommendation. In addition, increasing intramural sports programs and after-school programs that incorporate physical activity will contribute toward this goal. 
<P>Many schools are working to overcome barriers to students walking to and from school. Safe Routes to School, a program implemented throughout the United States and Canada, uses education and incentives to encourage students to walk and bike to school safely. The program addresses the safety concerns of parents by promoting enforcement of traffic laws, exploring ways to create safer streets, and educating the public about pedestrian safety. For information, visit the Web sites of the National Center for Safe Routes to School (<a href="http://www.saferoutesinfo.org">www.saferoutesinfo.org</a>), the Federal Safe Routes to School Program (<a href="http://safety.fhwa.dot.gov/saferoutes">http://safety.fhwa.dot.gov/saferoutes</a>), or the Safe Routes to School National Partnership (<a href="http://www.saferoutespartnership.org">www.saferoutespartnership.org</a>).
<P><B>Provide worksite health promotion for school staff members.</B> In the course of teaching about nutrition and physical activity, educators may find themselves questioning their own diet and physical activity patterns. No one is perfect; the quest for a balanced lifestyle that incorporates regular physical activity and a nutritious diet is a lifelong one. Health screenings and health education programs can provide information and impetus for staff members to improve their lifestyles. Staff members can then serve as role models for students and be better able to speak about the benefits of good nutrition and regular physical activity. Consider teaming up with the school nurse to pursue grant funds to support health-promotion programs for staff members. Grants may be available through local community-based organizations (for example, the local chapter of the American Red Cross or Lions Club), state agencies, or national organizations. A healthier staff brings the additional benefit of fewer days of work missed for illness and other health-related issues.
<P><B>Conclusion</B>
<P>A schoolwide commitment to obesity prevention can begin with a comprehensive approach or a single step. The object is to help students understand that adopting a healthy lifestyle now will reap great rewards--physical and nonphysical--for their teens and beyond.
<P><B>References</B>
<P>Gortmacher, S. L., Peterson, K. E., Wiecha, J. L., Sobol, A. M., Dixit, S., Fox, M. K., & Laird, N. (1999). Reducing obesity via a school-based interdisciplinary intervention among youth. Planet Health. <I>Archives of Pediatric & Adolescent  Medicine, 153</I>(4): 409-418.
<P>Li, Y., Qi, D., Jackson, J. C., & Zhang, J. (2008). Overweight is associated with decreased cognitive functioning among school-age children and adolescents. <I>Obesity, 16</I>(18), 1809-1815.
<P>Strauss, R. S., & Pollack, H.A. (2000). Childhood obesity and self-esteem. <I>Pediatrics, 105</I>(1), 1-5. 
<BR><BR><BR>
<P><I><B>Christine Blaber</B> (<a href="mailto:cblaber@edc.org">cblaber@edc.org</a>) is the deputy center director of Education Development Center Inc.</I> 
<P><I><B>Leslie F. Hergert </B>(<a href="mailto:lhergert@edc.org">lhergert@edc.org</a>) is the managing director of Education Development Center Inc. and directs the AIM at Middle Grades Results project.</I>

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